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<h1> Add Comments </h1>
<h4 align="right">&nbsp;</h4>
<hr>

<table width="100%">
<tr>
	<td><b>Client Profile</b></td>
	<td>&nbsp;</td>
</tr>
<tr>
	<td><b>Presenting Issues</b></td>
	<td><font size="2">(different issue each line)</font></td>
</tr>
<tr>
	<td>1.</td>
	<td><p>_______________________________________________________________________________</p>
	  </td>
</tr>
<tr>
	<td>2.</td>
	<td><p>_______________________________________________________________________________</p>
	  </td>
</tr>
<tr>
	<td>3.</td>
	<td><p>_______________________________________________________________________________</p>
	  </td>
</tr>
<tr>
	<td>4.</td>
	<td><p>_______________________________________________________________________________</p>
	  </td>
</tr>
<tr>
	<td>&nbsp;</td>
	<td>&nbsp;</td>
</tr>
<tr>
	<td><b>Options Discussed</b></td>
	<td><font size="2">(different option each line)</font></td>
</tr>
<tr>
	<td>1.</td>
	<td>_______________________________________________________________________________</td>
</tr>
<tr>
	<td>2.</td>
	<td>_______________________________________________________________________________</td>
</tr>
<tr>
	<td>3.</td>
	<td>_______________________________________________________________________________</td>
</tr>
<tr>
	<td>4.</td>
	<td>_______________________________________________________________________________</td>
</tr>
</table>
<p></p>
<hr>
<p></p>
<table width="100%">
<tr>
	<td>Do you have a Case-Worker/Cousellor/Doctor?</td>
	<td><input type="radio" value="Y" name="optCCD">
	Yes
<input type="radio" value="N" name="optCCD">No</td>

	<!--
	<td><b><i>This does NOT give Camcare permission to contact worker</b></i></td>
	<td><b><i>(For information only)<br />
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</tr>
<tr>
	<td>If yes:</td>
	<td>&nbsp;</td>
</tr>
<tr>
	<td>Name of worker:</td>
	<td><p>_____________________________________</p>
	  <p>&nbsp;</p>
</tr>
<tr>
	<td>Name of Organisation:</td>
	<td>_____________________________________
</tr>
</table>

<p></p>
<hr>
<p></p>

<table>
<tr>
<td>&nbsp;</td>
</tr>

<tr>
<td>Client Signature:
</td>
<td><input type="radio" value="Y" name="optClientSignature">
Yes
<input type="radio" value="N" name="optClientSignature">No</td>
</tr>

<tr>
<td>Time Taken: </td>
<td><p>___________________</p>
  </td>
</tr>

<tr>
<td>Interviewer: </td>
<td>___________________</td>
</tr>

</table>

<p></p>
<hr>
<p></p>

<TABLE width="100%">

<tr>

<td align="center">
</td>

</tr>

</TABLE>

</form>

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